HomeMy WebLinkAboutRLC94-0426 for BLD94-00232 - RLC Inspections - 3/8/1994 Date Received:
MASON COUNTY
Ktqq * 0qDEPARTMENT OF COMMUNITY DEVELOPMENT
ate RESOURCE LANDS A ND CRITICAL AREAS CHECKLIST
The following checklist is designed to assist an applicant for a Building Permit, On-Site Sewage System Site
Evaluation and Disposal Permit, Access Permit, Land Modification Permit, Boundary Line Adjustments, Land
Segregations, Hazardous Waste Permit, or Shoreline Permit in determining whether their property is affected by
regulations under the Mason County Interim Resource Ordinance (77-93)*. This checklist is an important
opportunity foridentifying earlvin the permit process whether there will be any environmental regulations affecting
the proposed development.
Owner �' LLP-L'x - ACM'Vl^LJV\� LO C. L _
Phone #(20� ) g22 �7�7
Site Address '2 y S M b so-i (. k `D IDS& City Sf7 I�a►� Zip 9858�/
Owner Address J4(�,03 N- Z. �/Sfh Cityl�/Rk1RN4 State�Zip 980-33
Tax Parcel No. (Clonfign with Assessors Office)_ �a`�� 33 - 2 - Legal Description_
L.., --� �('✓l In � ��
Project Description 13U k 4 ' X 3Cor g2 s(zor w 1" 1X 1
Couz" deck
Directions to site (Please attach map) 1-1 W ci 3 Not, 4o 4sdr► I(jrhwh 2J.
'5�01P 51�i V) V44 w1450V1 �Lk )IDe S-0,54 (JUP-l" a45I md,5o►) Lk De E:qsf—
:LUZv, I��� I n-lo dyeluc�,wti
Please provide or attach a vicinity map which includes cross streets, major roads, creeks, etc.
V�l
Answer the following to the best of your knowledge. County-wide maps showing general locations of critical areas
Orrlci,l and resource lands are available for review at Mason County Department of Community Development, Planning
Use Only Department.
Do any of the following exist on this property or within 200 feet of this property?
County Yes No ElEl �4 /
� 1. Saltwater shoreline or a lake 20 acres or larger? -�11,CG'
❑ 2. Rivers, streams, or creeks with year-round flow? `—
❑ ❑ ® 3. Rivers, streams or creeks with intermittent flow but are within a clearly defined channel?
❑ ❑ ® 4. Lakes or ponds less than 20 acres in size? P
❑ ❑ ® 5. Wetlands: Areas that are inundated or saturated by surface water that under normal circumstances
support vegetation adapted for life in such conditions; such as marshes, bogs, and swamps. (See County
Maps for guidance.)
❑ ❑ 6. Slopes greater than 15% (8.5 degrees)? (See the County Landslide and Erosion Hazard Maps for
guidance.) cld
LJ L.J 7. Floodplains?y(S1ee, County Federal Emergency Management Maps and County Seismic Hazard Map
for guidance.) r,,", '
�] ❑ R 8. Seismic Hazard Areas? (S�e County Federal Emergency Management Maps and County Seismic
Hazard Map for guidance.)
You may be provided nuisance protections by the County for certain resource activities. If you are enrolled in any
of the following programs:
Count Yes No
❑ ® 1. Agricultural Open Space Taxation Program, RCW 84.33
❑ N 2. Open Space Timber Taxation Program, RCW 84.33, or Designated Forest or Classified Forest,
RCW 84.34
* Copies are available at Mason County Department of Community Development for $5.00 each.
RESOURCE LANDS & CRITICAL AREAS
- ; SITE PLAN
PLEASE SHOW THE FOLLOWING INFORMATION OR PROVIDE SURVEY MAP IF POSSIBLE:
► Location &dimensions of existing &proposed property boundaries. ► Approximate slope of land (grade &direction), topography.
► Identify legal access including, width of all road right-of-ways&easements. ► Location of significant natural features (water bodies, rivers).
► Locate all existing & proposed structures,drainfields, wells &driveways. ► Project description
Scale 1"= North Arrow
3 (4-H v) ck ed sk cC- .5
state tha ave answe d the above truthfully to the best of my knowledge.
Applicant/Owner Date
FOR OFFICIAL USE ONLY
Adjacent property.
!f —Using CUunty Resource Land Maps. this 'property is designated as:
La corm 00rmorl✓ial Forest:— Shoreline Master Pr4grarlx
2, Inholding Land' . Does not apply.
xxi
Mineral Resource Lind
Date
DCD
There is a $40.00 application fee for the Resource Land & Critical Areas Checklist. Make checks payable to the Mason
County Treasurer.
When completed, this form becomes part of the permit application.